Hepatitis C Treatment With Direct-Acting Antivirals in Kidney Transplant: Preliminary Results From a Multicenter Study
Hepatitis C Treatment With Direct-Acting Antivirals in Kidney Transplant: Preliminary Results From a Multicenter Study
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DOI：
10.1016/j.transproceed.2016.07.034
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发表时间：
2016-11-01
影响因子：
0.9
通讯作者：
Sanchez-Fructuoso, A.
中科院分区：
文献类型：
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作者：
Gentil, M. A.;Gonzalez-Corvillo, C.;Sanchez-Fructuoso, A.
丙型肝炎（HC）是影响移植物和移植受者生存的一个非常相关的负面预后因素。新的直接作用抗病毒药物（DAAs）使我们能够有效地解决这一问题。理解它们在我们日常实践中的真正影响至关重要。我们分析了来自15家西班牙医院（Grupo Espanol de actuizion en Trasplante）的肾移植受者（KTRs）使用不含干扰素的DAA的治疗结果，包括有效性、耐受性以及对免疫抑制、肾功能、蛋白尿和糖尿病的影响。共纳入119例ktr（9例肝肾联合移植）。使用的主要DAA是索布韦（91%）联合地帕韦（55%）、西莫普韦（14%）或daclatasvir (13%)；9例（7%）使用paritaprevir- ritonvir -ombitasvir-dasabuvir联合治疗（3D）；18%的患者使用利巴韦林作为辅助佐剂。副作用有限（23.5%），总体上没有相关性，除了7例因利巴韦林或其他药物相互作用（3D和他克莫司）引起的神经毒性(1)或贫血(3)而需要中断治疗的患者。分析数据时，94例患者已完成治疗：97.8%的病例出现病毒学应答。肝功能分析改善：84%正常，而治疗前为21% （P < 0.001）。肾功能和蛋白尿没有变化。daa治疗结束时的他克莫司水平与开始时相比显著降低（5.8 +/- 2.1 ng/mL vs. 7.4 +/- 1.8 ng/mL, P = 0.03），尽管剂量略有增加（2.6 mg/d vs. 2.3 mg/d, P = 0.17）。总的来说，DAA治疗ktr患者丙型肝炎疗效显著，耐受性好，使我们移植患者的问题得到解决，并有很好的机会改善预后。在ktr中使用这些疗法需要与消化专业人员进行特殊控制和协调，特别是如果使用3D或利巴韦林。
Hepatitis C (HC) is a very relevant negative prognosis factor for graft and transplant recipient survival. New direct-acting antivirals (DAAs) allow us to solve this problem in an effective way. It is crucial to understand their real impact in our daily practice. We analyzed treatment results with DAA, free of interferon, in kidney transplant recipients (KTRs) from 15 Spanish hospitals (Grupo Espanol de Actualizacion en Trasplante), regarding effectiveness, tolerance, and impact on immunosuppression, renal function-proteinuria, and diabetes. One hundred nineteen KTRs were included (9 combined liver-kidney transplants). The main DAA used was sofobusvir (91%) combined with ledipasvir (55%), simeprevir (14%), or daclatasvir (13%); in 9 cases (7%), a paritaprevir-ritonavir-ombitasvir-dasabuvir combination (3D) was used; Ribavirin was used as a coadjuvant in 18%. Side effects were limited (23.5%) and without relevance in general, except in 7 patients for whom we needed to interrupt the treatment due to neurotoxicity (1) caused by drug interaction (3D and tacrolimus) or anemia (3) by Ribavirin or others. Ninety-four patients had completed the treatment when data were analyzed: virological response was seen in 97.8% % of cases. Liver function analysis improved: 84% normal versus 21% before starting the treatment (P < .001). Renal function and proteinuria did not change. Tacrolimus level at the end of DAA-treatment was significantly lower with respect to the beginning (5.8 +/- 2.1 ng/mL vs. 7.4 +/- 1.8 ng/mL, P = .03), despite a slight increase in the dose (2.6 mg/d vs. 2.3 mg/d, P = .17).DAA are highly effective in the treatment of hepatitis C in KTRs with good tolerance in general, making it possible to solve the problem and have a good chance to improve the prognosis in our transplantation patients. The use of these therapies in KTRs requires special control and coordination with digestive professionals, especially if 3D or Ribavirin is used.